I passed the NCLEX in 2008 (First attempt, 34 minutes!), as of now I’ve been an RN for about four years. I live on the coast of Connecticut, USA. Since getting licensed, I’ve supervised in a nursing home for about three years (40 beds, 2 LPNs, 4 CNAs and myself). Currently I’m a Primary Care Nurse (case manager) for Hospice of Southeastern Connecticut (http://www.hospicesect.org/). I have a caseload of 10-13 home-care patients, some of whom have elected the Medicare Hospice Benefit and some who are still pursuing treatment (palliative). I’ve been at this organization for about a year and a half, I’ve been a full-time PCN for about seven months. One of the fun things about this job is clinical outreach activities to nursing home and hospital nurses where we give presentations on clinical topics relevant to end-of-life care.
What made you decide to become a nurse?
After an unsuccessful bid to get a degree in computer science engineering I floated around a few different jobs living paycheck to paycheck. After getting fired from Radioshack (for missing a weekend meeting that I was usually the only attendee for) a friend got me a job in a residential group home with five multi-diagnosis adults with mental retardation and autism. I was apprehensive about the job at first, especially the prospect of assisting with toileting and bathing. Once I got into it, I not only enjoyed the work but also became critical of the way other employees treated the clients. There was one RN for every 40 or so of these group homes, we were delegated medication administration in the form of a 4 week class taught by an RN. At the end of the class, the RN told us that if we liked this kind of work and were good at math and science we should get degrees in nursing and triple our paychecks. I then went on to get bounced out of the company (The May Institute) for reporting one of my coworkers to the state for abusing one of the clients. They kept moving her from home to home, with residents who were less verbal and more behavioral so no one would notice the difference. This was one among many factors that motivated me to join the profession.Sure enough, my first position as an RN paid fully triple what I made as an unlicensed group home worker. I never looked back after that, right from my first clinical rotation as a student on a med/surg unit I knew I had found my career.
Did you find your training prepared you for what actually goes on at the bedside? What sort of things really opened your eyes when you first began working ‘on the floor’?
Not exactly. I believe I received an excellent clinical education, we spent many more hours at the bedside than many of the other local nursing programs. Experience in sales and bartending (really!) did as much to prepare me for patient care as clinical training (Bartending – you listen to people’s problems, administer dangerous substances to them and evaluate the results!). A couple days a week is not the same as doing it full-time. A lot of nurses gave me heck for not working as a CNA first, and admittedly the learning curve was pretty intense going from a four-bed assignment as a student on a med/surg unit to supervising a 40 bed facility. It took a lot of working closely with some excellent CNAs and LPNs who were kind enough to take me under their wing for months before I felt confident I could carry out any task that takes place in the facility if the situation required. The biggest eye-opener for me was seeing patient care take second priority next to profit. I found myself in conflicts I never would have thought possible, and I earned the respect of my elders and betters over the years by putting my patients first no matter what. It was at this post that I met nurses from the agency I work for now, a non-profit hospice home care agency. When they would come to our facility to consult I was impressed by how thorough, holistic and patient-centered their care was. While the nursing home wasn’t the best environment for professional growth and safe nursing practice (more like the wild-west meets The Office), I met the nurses who would become my future mentors and teachers while I was there. It was commonly said by all the students who graduated before us “the real learning starts when you graduate”, not because we hadn’t learned a great deal, but a lot of the job defies description, let alone lesson-planning.
Tell us a story: an amazing, funny, moving or memorable moment from your book of shifts.
It was fourth of July, and I was supervising at the nursing home over the weekend. The adjoining 400-apartment independent living residences next door suffered widespread facility failures. Residents were trapped inside their apartments by scalding sheets of water, power was spotty, and I had to respond to no less than SEVEN separate emergencies in a single shift. Usually someone would pull an emergency cord once or twice a week. Usually it was a little-old-lady trying to jump from bed to carpet wearing slippery pantyhose, sometimes it was a cat, but it could just as easily be a COPD exacerbation, stroke or seizure. That day people were breaking ribs, gashing legs/arms/hands, one person reported they had dislodged their jaw eating an ear of corn at the picnic. Had to call for an ambulance three times and must have walked 5 miles. It was exhausting and I had to stay late to catch up on charting, but I was grinning from ear to ear through the worst of the disaster. As a student nurse I always wanted to get in to emergency nursing, and for that one crazy day as a nursing home supervisor I got my wish!
Number Two involves my first director of nursing. Months after she hired me, she started belittling me, berating me, generally treating me like a child and making my life miserable. I suffered this for months until one day I submitted a medication error report to her – I had found an unconsumed and unattended antihypertensive in a paper cup in one of the rooms and did all the appropriate steps, calling the MD and getting orders, taking vitals, documenting, etc. I handed it in and headed out on my med-pass. Half-way through, the first-shift nurse shows me the paper cup with the unconsumed pill in it and then tells me who it was for and when it was supposed to have been taken. I explained that I realized this and that I had already written a medication error report about it. The report was never filed. I alerted the administrator and they walked her out of the building the next day for falsifying records. I went on to supervise there for a couple (of wild and memorable) years after that until the place imploded into profit motivation and office politics. A story for another time.
Not just a nurse: what about when you are not at work? What do you get up to in the rest of your life?
Lately I’ve been scaling back on the activities. I was playing trombone in a couple of bands for a while, studied martial arts (aikido) and zazen for a couple years, but now that I’m settled into my career full-time, I don’t really feel like pursuing any of those interests any more. I have homework for my RN to MSN schoolwork (at Sacred Heart University in Fairfield CT) to keep me busy, and when I’m not at work you can usually find me in the pub with my nose stuck in a laptop. I’ve been reading a lot of sci-fi on my smartphone, lately I’ve been into Vernor Vinge. I’ve been on a singularity kick lately, on my off time I’ve blown through the novels of Charles Stross, Rudy Rucker, Peter Watts, Cory Doctorow and people in that vein – usually at the rate of a novel every two or three days I find time to read. I’ve cultivated a lot of different interests for short periods of time over the course of my life, I’ve enjoyed reading about philosophy and the psychology of religion, semiotics, game theory, Chinese astrology, computer science, mysticism and ethnobotany. Some of my newest interests include Biosemiotics, Cryptoforestry and augmented reality technology. I’ve had a long relationship with the game of Go/Baduk/Wei qi, I could spend hours playing it, which usually means spending hours teaching it to people because of how obscure it is in this country. I’ve had a life-long relationship with video games as well, I’ve seen them progress from simple black-and-white affairs to big-budget realistic simulations that rival Hollywood movies in their ability to tell a story and deliver content. There’s plenty of evidence that gaming (if the right games are played) can strengthen cognition and dexterity, and I think gaming and the art of the user interface is going to become much more important as our world and the associated data -about- our world becomes exponentially more complex. I jealously guard my free time, my time away from my nursing career. I prefer not to have any obligations or projects during this period. I enjoy hanging out with friends and pursuing my own interests. I like to rest, when I’m not at work, and enjoy the simple freedom of not being in charge of anything and not being responsible for everything.
Piss and Vinegar: name 3 things that really get under your skin, push your buttons, or generally irritate you at work or outside of work.
Caregiver neglect. A wise woman who was our clinical instructor for our forensic psych rotation told us that in her 20 years of working in maximum-security forensic psych as an RN, the number one threat to the health and welfare of her patients was caregiver neglect. The more I worked, the more I believed it. Once I delivered breakfast trays to five specifically selected alert and oriented rehabbers at the nursing home, asked them to let me know if their blood pressure had been taken by the time I returned with lunch. All five had blood pressures written down in the CNA book, but all five claimed no one had taken their blood pressure. When asked, each pair of CNAs claimed they “did them all together”. The administrators sat on my written report and did nothing, of course, but it was gratifying to have caught them (one important lesson I learned about private health care corporations. They don’t care about doing the right thing, only not getting caught). I enjoy strategy games, and all the years reading psychology started paying off big-time. I used applied behavioral analysis to stop the CNAs from standing as they shoveled foods in the residents mouths. A more pleasant and civilized time was had by all, even the CNAs. I don’t mean to single out CNAs here, I have vicious and biting criticism for some of the things I’ve seen my fellow nurses do too (and MDs and Social Workers), but any of them would be too complicated to explain briefly.
Tribal knowledge / tradition. People aren’t skeptical enough when they ask other people for advice. It’s easy to just stop thinking and carry out the suggested course of action, but hilariously bad mistakes can become routine if this is left unchecked. No matter how clever something sounds, look it up! Lump into this category clinical decisions based on belief rather than evidence. Case in point, evidence for giving strong anticholinergic medications for terminal secretions or the “death rattle”. Every journal article I found measured it’s effectiveness in terms of how disturbed the family members were by the process. The problem with this is that someone who isn’t conscious enough to be able to clear their airway (or respond to stimuli) is not awake enough to be disturbed by the noise. Is it ethical to give a -patient- a medication for the benefit of the -family member-? I tend to think not, sometimes education is more effective then medication, and non-pharmacological interventions should at least be tried -first-. You can make the family members less disturbed by educating them. Also, anticholinergics dry your mouth out, and maintaining mouth moisture should be done -at least- hourly once PO intake ceases. Not that this medication isn’t useful sometimes, I just think it’s overused. Look up how expensive inject-able Glycopyr
Office politics / lateral violence. Isn’t this job hard enough? Seriously.
Bonus round: The way information technology is implemented in health care. Take electronic charting. Every product I’ve tried plays like it was designed by the lowest bidder. Nurses should be given technology to help them share and understand, not just to fill up Minimum Data Sets. Information technology in the nursing profession hasn’t come anywhere near recognizing it’s potential to improve outcomes. I’m excited to see what nurse informaticists come up with, once that specialty really gets up and running. Count me out, though, as long as my back holds out I’ll be at the bedside.
The nurses desk: What is the one thing you would like to say to the rest of the nurses or general public out there.